卡尔加里大学Michael D. Hill小组取得一项新突破。他们报道了短暂性脑缺血发作或轻度卒中后卒中的长期风险。2025年3月26日，国际知名学术期刊《美国医学会杂志》发表了这一成果。

重要性:短暂性脑缺血发作（TIA）或轻微中风后，中风的长期风险尚不清楚。

目的:确定TIA或轻微中风后10年内的年发病率和累计发病率。

数据来源：MEDLINE， Embase和Web of Science从成立到2024年6月26日进行了搜索。

研究选择：前瞻性或回顾性队列研究，报告TIA或轻度卒中患者在至少1年的随访期间卒中风险。

数据提取与合成 ：两名审稿人独立进行数据提取并评估研究质量。在离散随访期间，未发表的事件数和人年的汇总数据直接从纳入研究的作者处获得，以计算单个研究的发病率。所有研究的数据采用随机效应荟萃分析进行汇总。

主要成果和措施：主要结局是卒中。研究水平的特征作为研究中卒中发生率变异性的潜在来源进行了调查。

结果:分析涉及171068例，中位年龄69岁[IQR， 65-71]；男性患者的中位比例为57% [IQR， 52%-60%])，共纳入38项研究。每100人年卒中总发生率为5.94例(95% CI, 5.18-6.76；38岁的研究;I2 = 97%)，第一年为1.80例(95% CI, 1.58-2.04；25项研究;I2 = 90%)，在第二至第五年每年发生1.72例(95% CI, 1.31-2.18；12的研究;在第6年至第10年，每年（2=84%）。5年和10年累积卒中发生率分别为12.5% （95% CI, 11.0%-14.1%）和19.8% （95% CI, 16.7%-23.1%）。在北美（RR = 1.43）和亚洲（RR = 1.62）进行的研究中，2007年或之后招募的队列（RR = 1.42），以及采用主动与被动结果确定方法的研究（RR = 1.11），卒中发生率均高于欧洲。仅关注TIA患者（RR, 0.68 [95% CI, 0.65-0.71]）或首次指数事件（RR, 0.45）的研究卒中发生率低于未选择患者群体的研究。

研究结果表明，有过短暂性脑缺血发作或轻微中风的患者在随后发生中风的风险持续较高。这项研究的发现强调了在这一患者群体中改善长期卒中预防措施的必要性。

附：英文原文

Title: Long-Term Risk of Stroke After Transient Ischemic Attack or Minor Stroke: A Systematic Review and Meta-Analysis

Author: Writing Committee for the PERSIST Collaborators, Faizan Khan, Vignan Yogendrakumar, Ronda Lun, Aravind Ganesh, Philip A. Barber, Vasileios-Arsenios Lioutas, Naja Emborg Vinding, Ale Algra, Christian Weimar, Joachim gren, Jodi D. Edwards, Richard H. Swartz, Angel Ois, Eva Giralt-Steinhauer, Andrej Netland Khanevski, Xinyi Leng, Xuan Tian, Thomas W. Leung, Hong-Kyun Park, Hee-Joon Bae, Masahiro Kamouchi, Tetsuro Ago, Esmee Verburgt, Jamie Verhoeven, Frank-Erik de Leeuw, Bernhard P. Berghout, M. Kamran Ikram, Karel Kostev, William Whiteley, Toshiyuki Uehara, Kazuo Minematsu, Fredrik Ildstad, Simon Fandler-Hfler, Karoliina Aarnio, Bettina von Sarnowski, Matteo Foschi, Jing Jing, Minyoul Baik, Young Dae Kim, Michele Domenico Spampinato, Yasuhiro Hasegawa, Kanjana Perera, Francisco Purroy, Dipankar Dutta, Xiaoli Yang, Julian Lippert, Laura Myers, Dawn M. Bravata, Monica Santos, Sarah Coveney, Carlos Garcia-Esperon, Christopher R. Levi, Diane L. Lorenzetti, Shabnam Vatanpour, Yongjun Wang, Gregory W. Albers, Philippa Lavallee, Pierre Amarenco, Shelagh B. Coutts, Michael D. Hill

Issue&Volume: 2025-03-26

Abstract: Importance  After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke is not well-known.

Objective  To determine the annual incidence rates and cumulative incidences of stroke up to 10 years after TIA or minor stroke.

Data Sources  MEDLINE, Embase, and Web of Science were searched from inception through June 26, 2024.

Study Selection  Prospective or retrospective cohort studies reporting stroke risk during a minimum follow-up of 1 year in patients with TIA or minor stroke.

Data Extraction and Synthesis  Two reviewers independently performed data extraction and assessed study quality. Unpublished aggregate-level data on number of events and person-years during discrete follow-up intervals were obtained directly from the authors of the included studies to calculate incidence rates in individual studies. Data across studies were pooled using random-effects meta-analysis.

Main Outcomes and Measures  The primary outcome was any stroke. Study-level characteristics were investigated as potential sources of variability in stroke rates across studies.

Results  The analysis involved 171068 patients (median age, 69 years [IQR, 65-71]; median proportion of male patients, 57% [IQR, 52%-60%]) from 38 included studies. The pooled rate of stroke per 100 person-years was 5.94 events (95% CI, 5.18-6.76; 38 studies; I2=97%) in the first year, 1.80 events (95% CI, 1.58-2.04; 25 studies; I2=90%) annually in the second through fifth years, and 1.72 events (95% CI, 1.31-2.18; 12 studies; I2=84%) annually in the sixth through tenth years. The 5- and 10-year cumulative incidence of stroke was 12.5% (95% CI, 11.0%-14.1%) and 19.8% (95% CI, 16.7%-23.1%), respectively. Stroke rates were higher in studies conducted in North America (rate ratio [RR], 1.43 [95% CI, 1.36-1.50]) and Asia (RR, 1.62 [95% CI, 1.52-1.73]), compared with Europe, in cohorts recruited in or after 2007 (RR, 1.42 [95% CI, 1.23-1.64]), and in studies that used active vs passive outcome ascertainment methods (RR, 1.11 [95% CI, 1.07-1.17]). Studies focusing solely on patients with TIA (RR, 0.68 [95% CI, 0.65-0.71) or first-ever index events (RR, 0.45 [95% CI, 0.42-0.49]) had lower stroke rates than studies with an unselected patient population.

Conclusions and Relevance  Patients who have had a TIA or minor stroke are at a persistently high risk of subsequent stroke. Findings from this study underscore the need for improving long-term stroke prevention measures in this patient group.

DOI: 10.1001/jama.2025.2033

Source: https://jamanetwork.com/journals/jama/fullarticle/2832005